| Florida East Coast Medical Group Inc | |
|
1107 N Parrott Ave Okeechobee FL 34972 | |
| (863) 763-5122 | |
| (863) 763-1965 |
| Full Name | Florida East Coast Medical Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1107 N Parrott Ave, Okeechobee, Florida |
| Authorized Official Name and Position | Dmitry Mishelevich (V-P/CFO) |
| Authorized Official Contact | 8637636496 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Florida East Coast Medical Group Inc 1107 N Parrott Ave Okeechobee FL 34972-2128 Ph: (863) 763-6496 | Florida East Coast Medical Group Inc 1107 N Parrott Ave Okeechobee FL 34972 Ph: (863) 763-5122 |
| NPI Number | 1699954057 |
|---|---|
| Provider Enumeration Date | 11/01/2007 |
| Last Update Date | 07/09/2019 |
| Medicare PECOS PAC ID | 8729165279 |
|---|---|
| Medicare Enrollment ID | O20080408000306 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699954057 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ludmila Mishelevich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275551186 PECOS PAC ID: 1254319569 Enrollment ID: I20040713000334 |
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